Cost Proposal Worksheet v2
120 KB Posted
- Attached to
- Serological Immunoassay Lease and Services
- Solicitation number
- 40500-DPH0000066
- Issued by
- Georgia
About this file
This is a Cost Proposal Worksheet related to a Request for Quotes (eRFQ) issued by the Georgia Department of Public Health for Serological Immunoassay instrumentation lease and related services. The eRFQ was issued pursuant to the State Purchasing Act (Official Code of Georgia Annotated 50-5-50 et seq.) to establish a contract with a qualified supplier to provide a comprehensive range of services related to serological immunoassay instrumentation. The original eRFQ was canceled without award on February 24, 2014, at the Department's discretion, with the Department reserving the right to reissue a replacement bid event. The solicitation document provided is a cost proposal worksheet template intended for vendors to submit pricing information for the lease and services related to the instrumentation and associated support.
The cost proposal worksheet serves as the standardized format for respondents to provide their pricing terms and cost structure for the serological immunoassay lease and services contract. While specific pricing details, renewal options, contract term length, and other financial requirements are not detailed in the file summary provided, the worksheet would have required vendors to itemize costs associated with equipment lease, maintenance, support services, and any other related expenses. The cancellation and planned reissuance of the eRFQ suggests the Department was seeking to modify requirements or improve the procurement process prior to moving forward with vendor selection.
Text of this file
Instructions
| General | |
| General Information: As this program is funded entirely with federal dollars, strict rules exist regarding allowable and unallowable expenses. These rules are specified in Office of Management Budget (OMB) Circular A-133: Cost Principles for Non-Profit Organizations at http://www.whitehouse.gov/omb and http://www.whitehouse.gov/sites/default/files/omb/assets/a133/a133_revised_2007.pdf (HTML web link below). The DPH will review each offeror's proposed budget and work with success offerors to ensure all budgeted costs are allowable under OMB Circular A-133. |
Offerors must complete the budget details and justification in its entirety, no exceptions. Missing, incomplete, or inconsistent information can result in delays, disallowance of certain expenditure(s), in part or whole, and/or proposal disqualification.
The following detailed/line by line instructions for the Cost Proposal and Budget Details Justification Worksheet(s) are designed to facilitate ease of use in submitting pricing proposal. Please read the instructions entirely.
| # | Column/Field | Header / Function | Instruction Details | |
| Tab 1 | 1 | All | Instructions | Contain detail instructions for completing the Cost Proposal (Tab 2) and Budget Details and Justification (Tab 3) worksheets. |
| Tab 2 | 2 | G2 | Cost Proposal Worksheet | General Information |
Except for the date and company information fields, the Cost Proposal Worksheet (Tab2) is password protected. This worksheet contains the proposed budged summary and is automatically populated by data entered into corresponding fields on the Budged Details and Justification worksheet (Tab3)
The Cost Proposal Worksheet has limited access and cannot be manually changed. To reconcile data populated to Tab 2, double check figures entered on Tab 3 to ensure data accuracy.
Offeror MUST complete all yellow highlighted fields on Tab 2 Cost Proposal Worksheet
| 3 | G2 | Enter date of completion (this entry automatically populates the corresponding cell (H3) on Tab 3) | ||
| 4 | D9 | Enter Company's name (this entry automatically populates the corresponding cell (D3) on Tab 3) | ||
| 5 | D10 | Enter the company's business/physical address | ||
| 6 | D11 | Enter the company's business/physical city, state and zip code | ||
| 7 | F9 | Enter the contact person's name and title | ||
| 8 | F10 | Enter the contact person's phone number | ||
| 9 | F11 | Enter the contact person's business email address | ||
| Tab 3 | 10 | D-H,J | Budget Details Justification Worksheet | Budget Details and Justification Worksheet contain the budget line details and justification. This worksheet is interactive, except for cost totals at the end of each section. The cost total cells are set to automatically calculate each category and populate the corresponding cell(s) on Tab 2. |
Offeror is required to list all line items and provide justification, per the instructions, for each expenditure. Failure to provide justification may result in disqualification of the line item, expense, and/or proposal.
Please follow the line-by-line instructions below for completing this worksheet.
11 D Personnel Position Type/Title Enter the description or title of each position that will be assigned to work on the corresponding program. Also indicate if the position is full-time (FT) or part-time (PT). Do not list non-paid or volunteer positions in this section.
12 E Employee Name Enter the employee's first initial/last name (if available). Entries here must be supported by resumes' and job descriptions provided in response to the corresponding eRFx/contract agreement (where applicable).
13 F Annual Salary:
Enter 100% of the annual salary for this position/employee; even if the position/employee is assigned to work on multiple programs for this project. The annual salary relative to the individual program is automatically calculated in in the annual cost(s) field (Column I), which is predicated on the percent of program effort (Column H).
14 G Project (% of effort spent on the entire project):
Enter the percent of time the position/employee is expected to be allocated to this contract as a whole, during the term of this agreement. The employee's time allocation includes the sum total of time spent working on all activities/seminars outlined in the agreement.
15 H Program: % of effort spent per this specified activity only Enter the percent of time the position/employee will be assigned to work on this specific activity during the contract period. The sum total of the position's/employee's annual salary for all assigned activities shall not exceed 100% of the time allocated for the entire project.
16 I Annual Cost(s):
The field requires no manual entry. The annual personnel costs for this position/employee is set to automatically calculate by dividing the annual salary rate (Column E) by the program % of effort (column G).
17 J Justification:
Enter a description of the specific program's need(s), to include an explanation of how costs were estimated. Describe the job's function and/or how supplies/equipment will be utilized.
1. Offerors are required to provide a line item budget and narrative justification for all requested costs using the Budget Detail and Justification Worksheet provided (Tab 3).
2. A narrative budget justification (column J) is required for all budget line item details. The budget narrative must describe in sufficient detail exactly how the offeror calculated each of its budget line items and category totals. If additional space is needed, please cross reference each budget narrative with the corresponding budget line item and category/section.
3. Line items without valid justification can result in proposal disqualification either in part or whole.
18 D Supplies Item Description:
Enter on separate lines, supplies and materials expected for one-time usage. List program specific supplies under the related program(s) in the space provided. Supplies and materials may include but may not be limited to, pamphlets, brochures, etc. For specific rules related to covered supplies and materials, refer to the OMB Circular A-133: Cost Principles for Non-Profit Organizations.
19 E Rate/Cost:
Enter the rate/cost per each unit of measure 20 F Unit of Measure:
Enter the specified unit of measure (UOM), i.e., each, package, lot, daily, monthly, quarterly, annually, etc.
21 G Total # of Units:
Enter the quantity or the total number of units per year 22 I Annual Cost(s):
This field requires no manual entry. The annual cost(s) for "Supplies" is set to automatically calculate by multiplying the rate/cost per unit (Column E) by the total # of units/quantity, (Column G).
| 23 | J | Justification: Refer to G20 (above) | |
| 24 | D-H,J | Other | List other expenses not covered in any of the previous budget categories. Where applicable, other expenses may include but not limited to: costs related to media production, billboards, t-shirts, and other marketing items, staff and volunteer training (Personnel). Expenses listed here must not be included in the "Indirect cost" section. |
| 25 | D | Item Description: |
Enter on separate lines supplies and materials expected for one-time usage. List program specific supplies under the related program(s) in the space provided. For specific rules related to covered supplies and materials, refer to the OMB Circular A-133: Cost Principles for Non-Profit Organizations.
26 E Rate/Cost:
Enter the rate/cost per each unit of measure 27 F Unit of Measure:
Enter the specified unit of measure (UOM), i.e., each, package, lot, daily, monthly, quarterly, annually, etc.
28 G Total # of Units:
Enter the quantity or the total number of units per year 29 I Annual Cost(s):
This field requires no manual entry. The annual cost(s) for "Other" is set to automatically calculate by multiplying the rate/cost per unit (Column E) by the total # of units/quantity, (Column G).
| 30 | J | Justification: Refer to #17, field G20 (above) | |
| 31 | D-H,J | Travel | Travel costs entered here are related to the individual program. Be sure to explain need for all travel in the justification section. Local travel policies prevail. For specific rules related to covered supplies and materials, refer to the OMB Circular A-133: Cost Principles for Non-Profit Organizations. |
| 32 | D | Purpose of Travel: |
Enter the reason(s) for travel. For specific rules related to travel rules, refer to the OMB Circular A-133: Cost Principles for Non-Profit Organizations.
33 E Location:
Enter the starting location or city of origin (from) and the destination city/location (to).
34 F Item/UOM:
Enter the specified item or unit of measure (UOM), i.e., mileage, hotel, per diem, etc. For specific rules related to travel rules, refer to the OMB Circular A-133: Cost Principles for Non-Profit Organizations.
35 G Total # of Units:
Enter the quantity or the total number of units expected per year 36 I Annual Cost(s):
This field requires no manual entry. The annual cost(s) for "Travel" is set to automatically calculate by multiplying the rate/UOM (Column G) by the total # of units/quantity (Column H).
| 37 | J | Justification: Refer to #17, field G20 (above) | |
| 38 | D-H,J | Indirect Costs | Indirect Costs: |
Must not exceed 10% of total administrative costs Must not include costs already listed or otherwise accounted for in other categories Examples of indirect costs include but is not limited to: ____________________________________
| 39 | D | Cost Per Unit of Meaure (UOM) | Activity: Indicate the type of activity you expect to conduct for this project, i.e., seminar, workshop, ad campaign production, etc. |
| 40 | E | Total # of Units (seminars, activities, etc.): Indicate the total number of activities you expect to conduct for this project during the term of the agreement. The total number of activities must reflect the sum total of the minimum required plus the number of additional activities planned. The default or place holder number shown in the "Total Units/Activities" field represents the minimum number of required activities. Offerors planning to conduct more than the minimum number of activities or conducting community mobilization and/or surveillance, must indicate as such by increasing the default number to include the total number of activities planned in the corresponding cell. | |
| 41 | F | Cost per Unit (seminar, workshop, activity, etc.) is automatically calculated based on dividing the Total Annual Costs (each section) by the Total # of Activities. Offeror MUST enter the total number of units in the designated field for activities it plans to expedite. |
NOTE: The calculated cost per unit (activity, i.e., seminar, workshop, report, etc.) is based on the number of minimum activities required in the eRFx/agreement and is used for monthly reporting and invoicing. The monthly invoicing amount must be adjusted where the Contractor completes greater than the minimum number of required activities.
| 42 | J | Justification: Refer to #17, field G20 (above) | ||
| References | ||||
| 42 | GEN | Reference Links | OMB Circular A-133 | |
| Office of Management Budget (OMB) | ||||
| Circulars: Budget | The White House |
&C&"Arial Narrow,Bold"&12ATTACHMENT G Cost Proposal&"Arial Narrow,Regular"&10 &A &LGeorgia Department of Public Health Sexual Violence Prevention Education II eRFP #40500-DPH0000049&RPage &P of &N Printed on &D OMB Circular A-133 Circulars: Budget | The White House Office of Management Budget (OMB)
Cost Details
| Date: | ||||||||||
| 1 | Offeror Information | |||||||||
| Company Name | Contact Name, Title | |||||||||
| Address | Phone Number | |||||||||
| City, State Zip | Email address | |||||||||
| 2 | Instrument, Supplies and Services | |||||||||
| Item Description | Lease/Rate | # Units [Qnty] | Unit of Measure (UOM) | |||||||
| [ea., month, etc.] | Total # UOM [ea, months, etc.] | Annual Costs | ||||||||
| Decatur Instrument Lease: | <specify name/type here> | 1 | Month | 12 | $ - 0 | |||||
| Computer(s) Lease | 1 | Month | 12 | $ - 0 | ||||||
| Printers(s) Lease | 1 | Month | 12 | $ - 0 | ||||||
| Ancillary Equipment Lease: | <specify instrument name/type here> | 1 | Month | 12 | $ - 0 | |||||
| Controls, calibrators, reaction modules, etc. | 1 | Month | 12 | $ - 0 | ||||||
| Supplies: | <specify/list supplies here> | 1 | Month | 12 | $ - 0 | |||||
| PM visit(s): | <specify instrument name/type here> | 1 | Month | 12 | $ - 0 | |||||
| Training(s) [user, installation, etc.] | 1 | Each | 1 | $ - 0 | ||||||
| Travel Expenses (estimate) | 1 | Each | 1 | $ - 0 | ||||||
| Uninterrupted Power Source | (UPS) Unit(s) | 1 | Each | 1 | $ - 0 | |||||
| Miscellaneous expenses | (estimated) <specify> | 1 | Each | 1 | $ - 0 | |||||
| Decatur: Estimate Cost Lease/Service | $ - 0 | |||||||||
| Waycross Instrument Lease: | <specify name/type here> | 1 | Month | 12 | $ - 0 | |||||
| Computer(s) Lease | 1 | Month | 12 | $ - 0 | ||||||
| Printers(s) Lease | 1 | Month | 12 | $ - 0 | ||||||
| Ancillary Equipment Lease: | <specify instrument name/type here> | 1 | Month | 12 | $ - 0 | |||||
| Controls, calibrators, reaction modules, etc. | 1 | Month | 12 | $ - 0 | ||||||
| Supplies | <specify/list supplies here> | 1 | Month | 12 | $ - 0 | |||||
| PM visit(s) | <specify instrument name/type here> | 1 | Each | 1 | $ - 0 | |||||
| Training(s) [user, installation, etc.] | 1 | Each | 1 | $ - 0 | ||||||
| Travel Expenses (estimate) | 1 | Each | 1 | $ - 0 | ||||||
| Uninterrupted Power Source | (UPS) Unit(s) | 1 | Each | 1 | $ - 0 | |||||
| Miscellaneous expenses | (estimated) <specify> | 1 | Each | 1 | $ - 0 | |||||
| Waycross: Estimate Cost Lease/Service | $ - 0 | |||||||||
| Total Estimated Cost Lease/Service (Decatur & Waycross) | $ - 0 | |||||||||
| 3 | Reagent/Test Kits & Supplies | |||||||||
| The estimated number of units/tests used to calculate the cost per reagent/tests is based on the FY2013 utilization data for the Decatur Central and Waycross locations; and is not intended to guarantee a minimum or maximum order quantity. All relevant figures shown below will automatically populate the corresponding cell(s) of the Cost Proposal Worksheet (Tab 2). | ||||||||||
| Test/Reagent Name | Est # Units/Tests Decatur | Estimated Cost/Test Decatur | Est # Units/Tests Waycross | Estimated Cost/Test Waycross | Comments |
Explain cost/pricing variables, i.e., test type, volume, etc.
| Cytomegalovirus IgG | 826 | $ - 0 | - 0 | $ - 0 | ||
| Cytomegalovirus IgM | Cytomegalovirus IgM | 82 | $ - 0 | - 0 | $ - 0 | |
| HSV Type Specific 1 | HSV Type Specific 1 | 6,253 | $ - 0 | - 0 | $ - 0 | |
| HSV Type Specific 2 | HSV Type Specific 2 | 6,251 | $ - 0 | - 0 | $ - 0 | |
| Measles IgG | Measles IgG | 1,065 | $ - 0 | - 0 | $ - 0 | |
| Measles IgM | Measles IgM | 9 | $ - 0 | - 0 | $ - 0 | |
| Mumps IgG | Mumps IgG | 1,031 | $ - 0 | - 0 | $ - 0 | |
| Rubella IgG | Rubella IgG | 2,352 | $ - 0 | - 0 | $ - 0 | |
| Rubella IgM | Rubella IgM | 10 | $ - 0 | - 0 | $ - 0 | |
| Syphilis IgG/IgM | Syphilis IgG/IgM | 4,099 | $ - 0 | 936 | $ - 0 | |
| Toxoplasma IgG | Toxoplasma IgG | 1,333 | $ - 0 | - 0 | $ - 0 | |
| Toxoplasma IgM | Toxoplasma IgM | 434 | $ - 0 | - 0 | $ - 0 | |
| Varicella Zoster lgG | Varicella Zoster lgG | 1,431 | $ - 0 | - 0 | $ - 0 | |
| West Nile Virus IgG | West Nile Virus IgG | - 0 | $ - 0 | - 0 | $ - 0 | |
| Other (GPHL specified) | Other (GPHL specified) | - 0 | $ - 0 | - 0 | $ - 0 | |
| Total Tests/Facility | 25,176 | 936 | ||||
| Estimated Cost by Facility | $ - 0 | $ - 0 | ||||
| Total Estimasted Annual Cost | $ - 0 |
&C&"Arial Narrow,Bold"&12ATTACHMENT F Cost Proposal&"Arial Narrow,Regular"&10 &A Worksheet &LGeorgia Department of Public Health Serological Immunoassay Lease & Service, eRFQ 40500-DPH0000066&RPage &P of &N Printed on &D
Cost Proposal Worksheet
| Event Name: | Serological Immunoassay Lease and Services, GPHL | Date: | 12/31/99 | |||
| Event ID: | eRFQ 40500-DPH0000066 | |||||
| Offeror Name | ||||||
| Company Name | 0 | Contact Name, Title | 0 | |||
| Address | 0 | Phone # | 0 | |||
| City, State Zip | 0 | Email address | 0 | |||
| Section 5 “Cost/Pricing” | ||||||
| Unless otherwise specified in the solicitation (eRFx or Sole Source) or contract agreement, all pricing should be inclusive of all costs associated with providing the services outlined in the sourcing document (i.e. shipping, postage, etc.). Supplemental Cost Data is neither required nor desired. | ||||||
| Electronic Funds Transfer? | ||||||
| Remit to | ||||||
| Georgia Department of Public Health | ||||||
| Attention: | ||||||
| 2 Peachtree Street, NW | | Atlanta, Georgia 30303 | |||||
| COST PROPOSAL AND BUDGET DETAIL SUMMARY | ||||||
| Test/Reagent Name | Cost/Test Decatur | Cost/Test Waycross | Comments | |||
| Cytomegalovirus IgG | $ - 0 | $ - 0 | ||||
| Cytomegalovirus IgM | $ - 0 | $ - 0 | ||||
| HSV Type Specific 1 | $ - 0 | $ - 0 | ||||
| HSV Type Specific 2 | $ - 0 | $ - 0 | ||||
| Measles IgG | $ - 0 | $ - 0 | ||||
| Measles IgM | $ - 0 | $ - 0 | ||||
| Mumps IgG | $ - 0 | $ - 0 | ||||
| Rubella IgG | $ - 0 | $ - 0 | ||||
| Rubella IgM | $ - 0 | $ - 0 | ||||
| Syphilis IgG/IgM | $ - 0 | $ - 0 | ||||
| Toxoplasma IgG | $ - 0 | $ - 0 | ||||
| Toxoplasma IgM | $ - 0 | $ - 0 | ||||
| Varicella Zoster lgG | $ - 0 | $ - 0 | ||||
| West Nile Virus IgG | $ - 0 | $ - 0 | ||||
| Other (GPHL specified) | $ - 0 | $ - 0 | ||||
| Total Estimate/by Fac | $ - 0 | $ - 0 | ||||
| Total Annual Cost/Estimate Decatur/Waycross | $ - 0 | |||||
| The Cost Proposal Worksheet is automatically populated by data entered into the corresponding cell(s) on the Cost Details worksheet (Tab1) of this workbook. The estimated number of units [Qnty/annual] per test indicated is based on FY2013 utilization data and is not intended as a guaranteed minimum or maximum order quantity. | ||||||
| NOTE: The price of each test/reagent must be all inclusive of the kit, supplies and consumables to perform validation of new assay and related costs, as well as instrument(s), ancillary equipment, supplies, parts and labor, shipping, preventative and on-demand maintenance, telephonic and onsite technical support, training, travel, lodging, expenses, etc. | ||||||
| I attest the information contained in this Cost Proposal and supporting Cost Details Worksheet is an accurate estimate of our organization's financial proposal for this bid event. | ||||||
| Authorized Signature | Title |
&C&"Arial Narrow,Bold"&12ATTACHMENT G Cost Proposal&"Arial Narrow,Regular"&10 &A &LGeorgia Department of Public Health&RPage &P of &N Printed on &D No Yes (Authorization for ETF must be attached or on file
Budget Summary
| 11 | BUDGET SUMMARY: | ||
| Category | Per Unit Amt | Annual Amt | |
| A. Personnel | $ | ||
| Fringe Benefits | $ | ||
| B. Regular Operating | $ | ||
| C. Travel | $ | ||
| D. Equipment | $ | ||
| E. Supplies | $ | ||
| F. Per diem/ Fees/Contracts | $ | ||
| G. Telecommunications | $ | ||
| H. Other | $ | ||
| Total Direct Costs | $ | ||
| I. Indirect Costs | $ | ||
| Total Project Costs | $ |
Sheet1
| Test/Reagent Name | Est # Units/Tests Decatur | Estimated Cost/Test Decatur | Est # Units/Tests Waycross | Estimated Cost/Test Waycross |
| Cytomegalovirus IgG | 826 | $ 24.21 | - 0 | $ - 0 |
| Cytomegalovirus IgM | 82 | $ 243.90 | - 0 | $ - 0 |
| HSV Type Specific 1 | 6,253 | $ 3.20 | - 0 | $ - 0 |
| HSV Type Specific 2 | 6,251 | $ 3.20 | - 0 | $ - 0 |
| Measles IgG | 1,065 | $ 18.78 | - 0 | $ - 0 |
| Measles IgM | 9 | $ 2,222.22 | - 0 | $ - 0 |
| Mumps IgG | 1,031 | $ 19.40 | - 0 | $ - 0 |
| Rubella IgG | 2,352 | $ 8.50 | - 0 | $ - 0 |
| Rubella IgM | 10 | $ 2,000.00 | - 0 | $ - 0 |
| Syphilis IgG/IgM | 4,099 | $ 4.88 | 936 | $ 16.03 |
| Toxoplasma IgG | 1,333 | $ 15.00 | - 0 | $ - 0 |
| Toxoplasma IgM | 434 | $ 46.08 | - 0 | $ - 0 |
| Varicella Zoster lgG | 1,431 | $ 13.98 | - 0 | $ - 0 |
| West Nile Virus IgG | - 0 | $ - 0 | - 0 | $ - 0 |
| Other (GPHL specified) | - 0 | $ - 0 | - 0 | $ - 0 |
| Total Tests/Facility | 25,176 | $ 0.79 | 936 | $ 16.03 |
| Estimated Cost by Facility | $ 20,000.00 | $ 15,000.00 | ||
| $ 4,623.36 |
Other files
| File | Type | Posted |
|---|---|---|
| Suppliers Q & A | — | |
| Minutes_Bidders Conference | — | |
| Addendum 02 | — | |
| Addendum 04 Closing Date Exten | — | |
| Prebid Conference Information | — | |
| Addendum 03 | — | |
| Pre-Bidders-Offerors (2) | — |
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